In December 2011, Texas received federal approval of an 1115 waiver that would preserve Upper Payment Limit (UPL) funding under a new methodology, but allow for managed care expansion to additional areas of the state.

The purpose of the 1115 Healthcare Transformation waiver, supplemental payment funding, managed care savings, and negotiated funding will go into two statewide pools now worth $29 billion (all funds) over five years. Funding from the pools will be distributed to hospitals and other providers to support the following objectives: (1) an uncompensated care (UC) pool to reimburse for uncompensated care costs as reported in the annual waiver application/UC cost report; and (2) a Delivery System Reform Incentive Payment (DSRIP) pool to incentivize hospitals and other providers to transform their service delivery practices to improve quality, health status, patient experience, coordination, and cost-effectiveness.

Uncompensated Care Pool Payments are designed to help offset the costs of uncompensated care provided by the hospital or other providers.

DSRIP Pool Payments are incentive payments to hospitals and other providers that develop programs or strategies to enhance access to health care, increase the quality of care, the cost-effectiveness of care provided and the health of the patients and families served.

Under the transformation waiver, eligibility to get Uncompensated Care or DSRIP payments will require participation in a regional healthcare partnership. Within a partnership, participants include governmental entities providing public funds known as intergovernmental transfers (IGT), Medicaid providers and other stakeholders. Participants will develop a regional plan identifying partners, community needs, the proposed projects, and funding distribution. Each partnership must have one anchoring entity, which acts as a primary point of contact for HHSC in the region and is responsible for seeking regional stakeholder engagement and coordinating development of a regional plan.

The Texas Health and Human Services Commission (HHSC) is now proceeding with implementation of a five-year Section 1115 Medicaid Waiver, Texas Healthcare Transformation and Quality Improvement Program: Medicaid 1115 Waiver, which was approved by the Centers for Medicare and Medicaid Services (CMS) in December of 2011. Through this Waiver, we have an unparalleled opportunity to re-shape health care in our communities and improve access to quality, affordable care. As the public health care system for our region, JPS Health Network will serve as the anchor facility.

Planning and implementation of Waiver activities will be achieved through the development of Regional Health Plans. In the coming weeks, as the Tarrant County region is formalized, additional information will be posted on this web page, including an overall project timeline and information regarding stakeholder engagement.

In order to develop the most effective Regional Healthcare Partnership proposal to deliver better care at a lower cost to our patients and communities, JPS will issue a regional health plan assessment Request for Proposal (RFP) and planning process. This process is designed to ensure transparency in the development of a Regional Healthcare Partnership proposal that will represent the best interests of our region, while delivering value to patients, our state and federal government.